JFK's Medical Ordeals

Robert Dallek's article "The Medical Ordeals of JFK" (December Atlantic) is erroneous in a few areas. Kennedy did have a problem with chronic back pain, for which he had had surgery. He was treated in the Neurosurgical Department here at the Lahey Clinic, and the possibility of further surgery was raised in 1954. I had been at the Lahey Clinic for two years, and I clearly recall seeing the senator hobbling around on crutches, referred from neurosurgery to the Orthopedic Department, where conservative measures, including exercises and swimming, were advised.

The surgeons who saw him did not go to Cape Cod, as Dallek states. Nor did they suggest, as Dallek implies, that without surgery Kennedy might "lose his ability to walk." Such a profoundly untrue statement would never be made, even if spinal fusion was to be considered. The idea that he had "compression fractures" in his lower spine is also incorrect. There was undoubtedly some narrowing of the spinal disc space where surgery had been done previously, and it was because of this, not compression fractures, that spinal fusion must have been advised and carried out in New York a few months later.

Dallek's description of the devastating, almost fatal postoperative complication is accurate. The subsequent story of JFK's disabling back problem is indeed a tribute to his courage and determination. His condition following such spinal surgery is still amazing today. As Dallek points out, JFK endured a range of ineffective and ruinous procedures, as well as the many drugs prescribed, until he came under the care of Dr. Hans Kraus, whose advice—exercise, swimming, and physical therapy—resulted in significant improvement.

Charles A. Fager

Chairman Emeritus Neurosurgery

Lahey Clinic

Burlington, Mass.

Robert Dallek's medical history of John F. Kennedy supports an observation I have made repeatedly during more than thirty years as an orthopedic surgeon: celebrities rarely get good medical treatment. Most physicians, like most people, fear public failure. They tend to avoid a risky decision even if it is the best alternative. They also call in many consultants, and the consultants tend to be eminent and are rarely challenged. The result is medicine practiced by committee, each member of which is fearful of being wrong, and no member of which is likely to challenge another.

Jack C. Childers Jr.

Lutherville, Md.

President Kennedy was in a disease state we now classify as spondyloarthropathy. The genetic linkage of this category is well described in the medical literature as the haplotype of HLA-B27. The cluster of symptoms described by Professor Dallek as afflicting the former President include the likelihood of inflammatory bowel disease, Reiter's syndrome (urethritis, conjunctivitis, and arthritis), and ankylosing spondylitis, all of which fit into the spondyloarthropathy category. (The probability of the genetic linkage was recently made clearer to me when I had the opportunity to hold an outside door to the Senate building for JFK's brother Ted. His former height has given way to a stooping back, typical for the latter stages of this malady.)

Justus Fiechtner

Associate Professor of Medicine and Osteopathy

Michigan State University

East Lansing, Mich.

Robert Dallek presents us with evidence that JFK suffered greatly from medical disorders, chiefly colitis, spinal fractures from osteoporosis, and Addison's disease. Dallek does not attempt to classify JFK's colitis, but does refer to "wrestling" with "spastic colon" and, in an Atlantic Unbound interview, to "spastic colitis." The latter is an old term now generally subsumed under the name irritable bowel syndrome. IBS is a functional bowel disorder. It is extremely common. It is distressing. And its manifestations are at their worst when a person is under stress. On the basis of the evidence presented, I doubt that JFK suffered from IBS. An inflammatory bowel disorder is a more likely explanation, given the severity of his symptoms and his associated conditions. I think JFK suffered from celiac disease (gluten-sensitive enteropathy), a disorder in which sensitivity to ingested gluten, most commonly from wheat or rye, results in destruction of the lining of the small intestine. This typically produces symptoms of malabsorption and malnutrition. In support of this hypothesis I offer the following observations: 1. Celiac disease has a higher incidence among the Irish than in any other population (one in 300). 2. The malabsorption of calcium and vitamin D results in osteoporosis; a recent study in North America found osteoporosis of the lumbar spine in 38 percent of patients with celiac disease. 3. Celiac disease is associated with Addison's disease (screening for celiac disease is now recommended for patients with Addison's disease). 4. Celiac disease is associated with sacroiliitis and liver dysfunction, both of which were referred to or implied in Dallek's article. Although other inflammatory bowel disorders (Crohn's disease, ulcerative colitis) would explain some of these findings, they would have been easily diagnosed. Even now celiac disease is often not considered in the evaluation of patients with intestinal symptoms, and goes undiagnosed. If JFK is shown to have had celiac disease, people suffering from this highly treatable condition may get the attention they deserve.

Reuben Falkoff

San Diego, Calif.

Robert Dallek gives a startling revelation of JFK's health. Kennedy's primary illness was clearly inflammatory bowel disease, probably Crohn's disease. The onset is typically in the patient's second decade. All the other ailments were probably iatrogenic, including the Addison's disease and the collapsed vertebrae (osteoporosis). In defense of his physicians, especially early on, it should be noted that Crohn's paper describing the disease was not published until 1932 and probably was not widely appreciated for at least a decade.

The urethritis and prostatitis were more likely related to Kennedy's sexual dalliances. It is possible that he also had Reiter's syndrome (urethritis, arthritis).

The sad fact remains that unwarranted therapies caused him severe and unremitting pain and suffering.

Fred Pipkin

Louisville, Ky.

I read about JFK and his physicians Janet Travell and Hans Kraus with considerable interest, but both got a bum rap in Robert Dallek's article. Travell was criticized, and Kraus was stuck on the end of the story like a postage stamp. I write this in their defense. Both were my mentors. Both taught me well. Both helped me physically, and I knew each professionally and as a good friend.

I met Dr. Kraus in 1936, and became his rock-climbing partner in 1941 and his research assistant in 1954. His series of back-limbering exercises helped me avoid surgery on my back following a very bad ski accident in which I broke my pelvis in four places. The Kraus-Weber test for minimum muscular fitness, and our authorship of subsequent medical papers, took us to Dwight Eisenhower's White House to relate our findings on the un-fitness of American children and to launch fitness awareness in this country.

I met Dr. Travell in 1969, when I was trying to avoid a hip replacement relating back to the ski injury mentioned previously. Although she was unable to save the hip with injections similar to those given to JFK, she was able, with many injections over a period of six months, to make me more comfortable while I was waiting for the newly designed hip operation that she insisted I have. Her bedside manner was superb. I had been in a great deal of pain for years, and was under a lot of stress when I came to her. She put me in a JFK rocker with my feet up, wrapped me in a shawl, and talked to me in soothing tones. I immediately felt better and cared for. This must have been what JFK felt. To claim that she was kept on at the White House for fear she would "talk" is, I think, unfair. In all the years I knew Dr. Travell, never once—in our correspondence, phone conversations, or prolonged visits at my home in Stockbridge, Massachusetts—did she mention any difficulties at the White House.

Bonnie Prudden

Tucson, Ariz.

Robert Dallek replies:
Contrary to Charles Fager's recollections, Rose Kennedy remembered the Lahey physicians' visiting the Cape and encouraging JFK's fears about his future ability to walk without surgery. As for the absence of compression fractures, according to Dr. Jeffrey Kelman, x-rays for January 9, January 22, and October 13, 1954, in the records we studied at the JFK Library, suggest otherwise. Perhaps some of the discrepancies Dr. Fager describes could be cleared up if the Lahey Clinic opened its JFK medical records for study by future biographers. The alternative diagnoses suggested by other writers are certainly plausible, and I discuss these in my forthcoming book. As for Janet Travell and Hans Kraus, Bonnie Prudden's personal experience is no substitute for what the records in the library show.

Bobby Fischer

Rene Chun's description of the decline into paranoia (whether clinical or not) of Bobby Fischer ("Bobby Fischer's Pathetic Endgame," December Atlantic) offers a deeply saddening coda to Marjorie Garber's analysis of "genius" in the same issue. Unfortunately, Chun's discussion of Fischer's chess career contains several inaccuracies.

The "Game of the Century," played by Fischer against Donald Byrne in 1956, did indeed garner great admiration. However, the British master David Levy observed that the game's fame was caused by the youth of its winner, and that "had it been played in the Barnet league between two sixty-year-old men it is doubtful whether it would have been considered worthy of publication." The Brilliancy Prize that the game won was only for the best game of the tournament and not an annual award, and the exclamation mark is a standard annotation of a good move, not (as Chun implies) an extremely rare addendum to a commentary.

Chun goes on to criticize modern chess for the incredible level of preparation put in by top players that makes "the first twenty moves unfold like a stale sitcom plot." But he fails to note that Fischer himself, more than any other person, was responsible for this development. Fischer's chess monomania led to his victory over the Hungarian grandmaster Istvan Bilek in 1962, when Bilek used up his allotted two and a half hours of thinking time and thereby forfeited, having made only twenty-seven of the required forty moves. Fischer used exactly two minutes for the whole game, simply because he had prepared it all at home. Fischer's ascendance to the throne demonstrated to the chess world that a contender had to be a full-time competitor.

Chun's description of the Reykjavik match against Boris Spassky is intriguing. He correctly notes Fischer's superlative comeback from his poor start, but makes the rather odd claim that Fischer's play grew stronger throughout the match while Spassky "began ... to crack." This corresponds neither to the factual record (Spassky lost only one of the final eight games) nor to the subjective consensus on the match, which is that Spassky, but not Fischer, played his best chess during these games.

Bobby Fischer is clearly not an admirable human being, and many chess players find that this taints the beauty of his games. Nevertheless, they deserve to be accurately described.

Matt Guthrie

Phoenix, Ariz.

Your table of contents refers to Bobby Fischer as "the greatest chess player ever." This idea will get you laughed at by pretty much every serious chess player in the world. Even at his absolute peak Fischer was not nearly as great as Garry Kasparov, and probably not as good as Anatoli Karpov either.

Joshua B. Lilly

Martinsville, Va.

Bobby Fischer's former Hungarian girlfriend, Zita Rajcsanyi, may well have written a book about her relationship with the former chess champion, as reported by Rene Chun in the December Atlantic. If so, that would make two such books, because an earlier girlfriend, the German Petra Dautov, also wrote and published a memoir of her time with Fischer. I wonder if Chun mistakenly attributed Dautov's work to Rajcsanyi?

Robert Musicant

Norwalk, Conn.

Rene Chun replies:
The Brilliancy Prize was awarded for the best game of the tournament and is not, as Matt Guthrie notes, an annual prize. My mistake. I also regret making an error concerning the use of exclamation points in chess analysis. The exclamation point is standard annotation for a good move. Although Bobby Fischer obviously put an emphasis on studying opening theory, he was by no means the pioneer in that field. The Soviets made it a science long before Fischer came on the scene. Fischer just put in more hours. As for Boris Spassky's succumbing to the pressure of the Reykjavik match, this much is known: After the eighth game Spassky "sensed" that Bobby was hypnotizing him. After the fourteenth game Spassky called a meeting with his entourage of advisers and announced, "An attempt is being made to control my mind!" After the fifteenth game Spassky accused Fischer of using electronic devices and chemical substances to make him "lose [his] fighting spirit." Spassky's camp then insisted that the playing hall be searched for hidden electronic devices. "Spassky's snapped!" The New York Times wrote. "Now they're both crazy!"

By the standard of longevity alone, an argument could be made for Garry Kasparov's being the greatest chess player ever. But without Bobby Fischer there would be no million-dollar purses or televised matches. And victory in the 1972 world-championship match alone earns Fischer the title "greatest." This is not purely an American bias. When the international magazine Chess Informant asked its readers to pick the best chess player of the twentieth century, Robert James Fischer came out on top. Even Kasparov has called him "the greatest world champion."

Petra Dautov was indeed the woman who published a memoir chronicling her relationship with Bobby Fischer. I stand corrected.

Our Genius Problem

Since reading Marjorie Garber's "Our Genius Problem" (December Atlantic), I have repeatedly encountered other references to "genius"—in Time magazine, in a concert program, in the newspaper. But I noted as well the genius in the layout of your December issue: Garber's piece (wherein she refers to "the Repository for Germinal Choice—the 'genius' sperm bank founded in Escondido, California, by the eyeglass millionaire Robert Klark Graham") is immediately followed by Jessica Cohen's "Grade A: The Market for a Yale Woman's Eggs." The Centerpiece is Rene Chun's portrait of the flawed character of Bobby Fischer, the chess genius. David Brooks's "Light Shows of the Mind," in The Agenda, prepares us for Garber's views by saying that "Einstein was right when he said imagination is more important than knowledge." Finally, a subtle touch appears on page 147, in a review of John Updike's new novel: "Hope muses about her distant, Protestant God and ruminates about the role of the wife of a genius."

Patrick Ivers

Laramie, Wyo.

Marjorie Garber characterizes the IQ as an American invention. The IQ did become extraordinarily popular in the United States, but it was not Lewis Terman or any other American who invented it—it was William Stern (1871-1938), a German psychologist known for his work on differential psychology, who in 1912 first suggested dividing mental age by chronological age; he called this ratio the "intelligence quotient." In 1916 Terman adapted Stern's ratio, multiplying it by 100 to remove the decimal point, and abbreviated the term as IQ.

Nicole B. Barenbaum

Sewanee, Tenn.

The missing factor in genius that I found missing from Marjorie Garber's essay is one of sex. The vast majority of people labeled with the word "genius" are men. Even today one has only to troll the pages of book reviews to find young male writers labeled as "geniuses"; it's a term not often applied to women authors. And Garber's female example, Gertrude Stein, called herself a genius.

Although the MacArthur Foundation awards some of its genius grants to women, I cannot remember the last time a woman in our culture was crowned with such a laurel.

Lorraine Berry

Ithaca, N.Y.

Interracial Intimacy

Randall Kennedy's December article on the pace of and obstacles to black-white relations ("Interracial Intimacy") rings true. One unfortunate deduction to be drawn from this piece, however, is that the balkanization of the races is deeply entrenched, militating against integration at all levels as well as implying that separation should be maintained as the social norm.

This is in sharp contrast to the pattern in societies such as Canada and the United Kingdom, where, as recent studies have noted, intermarriage between blacks and whites is both more favorably viewed and more often practiced. In fact, blacks in Britain are marrying whites at four to five times the rate seen in America. The proportion of black men and black women entering into these unions is approximately the same, suggesting little of the black resistance underscored by Kennedy in the American experience. One reason given for this phenomenal difference is that British blacks, particularly in metropolitan London, do not tend to segregate themselves from whites. Another factor may be the early (1830) abolition of slavery throughout the British Empire, without a civil war. The "War to Free the Slaves" has left a bitter legacy that, despite the recent economic progress of blacks, tends to endure and to color relationships at many levels in the United States.

Harold S. Fleming

Great Falls, Va.

Certain well-off black males do tend to see white females as the third leg of the stool of visible worldly success, but the fact that white males marry black females in such small numbers is, to my mind, a much more interesting—and disturbing—topic.

White women bemoan the lack of suitable marriage partners to the same degree that black women do, though without much statistical support for their position. Yet with 25 percent of black males under the control of the criminal-justice system, and with college participation and graduation rates far higher among black females than among black males, educated black females have a legitimate complaint about the lack of compatible marriage partners. This theme is a constant in various forms of popular literature directed at African-American readers.

Why, given the availability of large numbers of educated and successful black women, do so few white males cross the color line to date and marry them?

Denton Taylor

Brooklyn, N.Y.

One of the most fascinating pieces of information in Randall Kennedy's look at interracial relationships concerns Amiri Baraka, the former LeRoi Jones. That New Jersey's poet laureate, who famously denounced the "4,000 Israelis" supposedly forewarned to stay away from the World Trade Center on 9/11, was once married to a Jewish woman is truly staggering. On second thought, perhaps it is no more staggering than Bobby Fischer's becoming a paranoid crackpot who abominates his heritage, adores Hitler, and spews the most odious brand of anti-Semitism. Baraka and Fischer: divided by color and culture but united by hatred for something familiar to them both.

Mindy Alter

Toronto, Canada

I was amused to come across my name in Randall Kennedy's fine essay on interracial marriages. Regrettably, some blacks and whites still think they have a right to an opinion about someone else's choice of a marriage partner.

A month to the day before he was assassinated, Malcolm X appeared on the Pierre Breton show, on CFTO-TV in Toronto, Canada, and was asked by Breton if he was still opposed "to integration and to intermarriage." Malcolm responded, "I believe in recognizing every human being as a human being—neither white, black, brown, or red; and when you are dealing with humanity as a family, there's no question of integration or intermarriage. It's just one human being marrying another human being, or one human being living around and with another human being." (Quoted in Malcolm X Speaks, 1966.)

Sadly, many blacks and whites have yet to grasp the simple truth in Malcolm's words.

Julius Lester

Belchertown, Mass.

The World in Numbers

This may be the most pedantic letter I've ever written, but ... the World in Numbers map in the December issue is color-coded by country, and Sardinia and Corsica are colored differently from Italy and France, to which they respectively belong. The same is true for Kangaroo Island—a speck off the southern coast of Australia.

Jonathan Kulick

Los Angeles, Calif.

W hat is bigger than Wyoming, more populous than Ireland, has English as an official language (like The Atlantic), lies 1,200 nautical miles east of Australia, and seems to have no hope of ever appearing on your world map?

Todd Krieble

Wellington, New Zealand

Early Admissions

Congratulations to James Fallows for influencing a change in early-admissions policy at Yale with his September 2001 article "The Early-Decision Racket." One thing I have never understood, however, is why students agree to the "binding" nature of early admission. Can one be penalized for accepting admission to a university and later changing one's mind?

I recall receiving early admission to a university and later enrolling in a different institution. I never heard from the university that offered me early admission. I can only assume that students who believe they are bound to attend the university that offers early admission have been fooled into this agreement.

Steven Knowlton

Ypsilanti, Mich.

James Fallows replies:

To qualify for early-decision plans, students must "agree" to attend the college if accepted—but there's no systematic penalty or enforcement if they renege. In theory, high school counselors are not supposed to send out transcripts to other colleges once a student has been accepted on a "binding" plan. Many colleges share lists of those they have accepted on a binding basis—and other colleges are free to tear up applications from those already accepted elsewhere. Sometimes it happens; sometimes, as Steven Knowlton found out, it does not.

Movie Presidents

I never thought that I would have a chance to correct a Pulitzer Prize-winning historian, but David M. Kennedy (The Agenda: "Ranking the Movie Presidents," November Atlantic) is mistaken when he identifies Tom Beck, the fictional character played by Morgan Freeman in Deep Impact, as "the first African-American President."

The first African-American President of the United States was Douglas Dilman, played by James Earl Jones in the 1972 movie The Man. Wait a minute: do dream sequences count? In that case the first African-American President (admittedly below the constitutionally mandated minimum age) was the title character in the 1933 movie musical Rufus Jones for President, played by a tap-dancing seven-year-old named Sammy Davis Jr.

F. Gwynplaine MacIntyre

Glasgow, Scotland

Iam outraged by the ranking of the movie Presidents by your so-called panel of experts. There can be no doubt that Jeff Bridges (in The Contender) stands head and shoulders above all the other movie Presidents. It is unforgivable that he was not even mentioned.

Nobody on your list comes close to matching his profound humor and humanity. And certainly nobody on your list can match his eloquence. (Morgan Freeman, himself seriously underrated, comes closest but still lags far behind.)

Andrew Eisner

New York, N.Y.

Advice & Consent

W hat an honor it was to have my article quoted by Jonathan Rauch in his recent Agenda column "The Fat Tax" (December Atlantic). An underground publication appreciates nothing more than a mainstream magazine's taking notice of it. However, I have to disagree with Rauch's assessment that the article contained "a hint of snobbery" in its reference to America's increasingly obese population. The facts are the facts, and we are not being snobbish to insist that Americans, despite all that is known about the dangers of an improper diet and extra weight, have created an epidemic of obesity.

Ken Wohlrob


Bully Magazine

Brooklyn, N.Y.

I was surprised to learn from Christopher Hitchens's article on Tom Stoppard's play The Coast of Utopia and its central character, Alexander Herzen ("A Nine-Hour Resurrection," December Atlantic), that my book on the latter is "highly controversial." I had assumed that my forty-odd-year-old Alexander Herzen and the Birth of Russian Socialism had been safely filed away as a staple of nineteenth-century Russian intellectual history.

Hitchens misunderstands the book. The sentence he cites—noting the paradox that in Russia socialism originated among the gentry, not among spokesmen for the proletariat—was not the expression of a "materialist view" of Herzen's ideas but the opposite: a way of explaining his socialism not on the usual basis of class but as the product of moral and intellectual concerns, and among the elite at that. My explanation is thus akin to that of Isaiah Berlin in the long quotation that Hitchens later supplies.

Hitchens also overdoes Herzen's stature as a "rival" to Marx and misjudges his peasant-based socialism as a "missed opportunity" for Russia. In fact Herzen's dream of building socialism in Russia on the foundation of the collectivist peasant commune, thereby beating advanced Europe to the end of history, was hopelessly utopian. His positive role, rather, was the more limited liberal one of launching an active opposition to Russian autocracy with his émigré newspaper, The Bell. Yet in this latter role he was soon overrun on his left by much harder socialists—"sons" against "fathers," in Turgenev's famous dichotomy. Through it all, as Hitchens aptly notes in his conclusion, Herzen displayed a talent for recording "the emotions of disaster and disillusionment" that permanently stalk the high-minded left.

Martin Malia

Professor of History Emeritus

University of California at Berkeley

Berkeley, Calif.

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